Çocuk femur diafiz kırıklarında Titanyum Elastik Nail (TEN) uçlarının cilt dışında bırakılması güvenli ve etkin midir?
Abstract
Amaç: Bu çalışmanın amacı, çocuk femur diyafiz kırıklarında Titanyum Elastik Çivi (TEN) uygulamasında çivi uçlarının cilt dışında ve cilt altında bırakılmasının geriye dönük olarak değerlendirilmesidir.
Hastalar ve yöntem: Ocak 2016 ile Temmuz 2019 tarihleri arasında femur diyafiz kırığı nedeniyle TEN uygulanan 46 hasta (47 kırık) geriye dönük olarak incelendi. Hastalar, çivi uçları cilt dışında bırakılanlar için Grup 1 ve çivi uçları cilt altında bırakılanlar için Grup 2 olarak adlandırıldı. Yaş, cinsiyet, kırık tarafı ve takip süreleri kaydedildi. Klinik değerlendirme; kalça ve diz hareket açıklığı (ROM), rotasyonel veya açısal deformiteler, pin dibi akıntısı, insizyon izleri ve enfeksiyon belirtileri; radyolojik değerlendirme ise anteroposterior ve lateral radyografilerde angulasyon, deformite ve uzunluk farkları üzerine yapıldı. İmplant çıkarılma süreleri ve gelişen tüm komplikasyonlar değerlendirildi.
Bulgular: Grup 1'de 21 kırıkta (TEN uçları cilt dışında bırakıldı), Grup 2'de ise 26 kırıkta (TEN uçları cilt altında bırakıldı). Her iki grup da yaş, cinsiyet ve kırık tarafları açısından benzer dağılıma sahipti. Grup 2'nin takip süresi anlamlı derecede daha fazlaydı (p 0,05), ancak her iki grupta da minimum takip süresi 9 aydı. Her iki grupta da koronal ve sagittal angulasyon dağılımları arasında anlamlı farklılıklar ortaya çıktı (p < 0,05), ancak angulasyon değerleri her iki yaş grubunda kabul edilebilir sınırlardaydı. Pin dibi akıntısı her iki grupta da benzer dağılıma sahipti (p > 0,05). Grup 1, implant çıkarma süresi açısından Grup 2'ye kıyasla daha kısa bir sürede başarı sağladı (p < 0,05). Her iki gruptaki tüm kırıklarda sorunsuz kaynama sağlandı. Hastalarda dikkate değer angulasyon kusuru, rotasyon kusuru veya kısalık gözlenmedi. Hiçbir hastada derin doku enfeksiyonu gelişmedi.
Sonuç: Pediatrik femur diyafiz kırıklarında TEN uçlarının cilt dışında bırakılması, poliklinik şartlarında ve anestezi gerektirmeden implantların kısa sürede çıkarılmasını sağlamanın yanı sıra, çivi uçlarının içeride bırakılmasıyla benzer güvenlikte olduğu için oldukça avantajlıdır. Ancak, çivi dibi enfeksiyonu hala ciddi bir endişe kaynağıdır. Bu nedenle, bu sorunun sıkı takip ve ebeveyn eğitimi ile çözülebileceği kanaatindeyiz.
References
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- 2. Kuremsky MA, Frick SL. Advances in the surgical management of pediatric femoral shaft fractures. Curr Opin Pediatr 2007;19:51-57 Kuremsky MA, Frick SL. Advances in the surgical management of pediatric femoral shaft fractures. Curr Opin Pediatr. 2007;19(1):51-7. doi: 10.1097/MOP.0b013e3280123142.
- 3. Uçar BY, Gem M, Bulut M, Azboy I, Demirtaş A, Alemdar C. Titanium elastic intramedullary nailing: closed or mini-open reduction? Acta Orthop Belg. 2013;79(4):406-10. PMID: 24205770.
- 4. Flinck M, von Heideken J, Janarv PM, Wåtz V, Riad J. Biomechanical comparison of semi-rigid pediatric locking nail versus titanium elastic nails in a femur fracture model. J Child Orthop. 2015;9(1):77-84. doi: 10.1007/s11832-014-0629-5.
- 5. Memeo A, Panuccio E, D'Amato RD, Colombo M, Boero S, Andreacchio A et al. Retrospective, multicenter evaluation of complications in the treatment of diaphyseal femur fractures in pediatric patients. Injury. 2019 Aug;50 Suppl 4:S60-S63. doi: 10.1016/j.injury.2019.01.009.
- 6. Govindasamy R, Gnanasundaram R, Kasirajan S, Ibrahim S, Melepuram JJ. Elastic Stable Intramedullary Nailing of Femoral Shaft Fracture-Experience in 48 Children. Arch Bone Jt Surg. 2018;6(1):39-46. PMID: 29430494
- 7. Combs K, Frick S, Kiebzak G. Multicenter Study of Pin Site Infections and Skin Complications Following Pinning of Pediatric Supracondylar Humerus Fractures. Cureus. 2016;8(12):e911. doi: 10.7759/cureus.911.
- 8. Kelly BA, Miller P, Shore BJ, Waters PM, Bae DS. Exposed versus buried intramedullary implants for pediatric forearm fractures: a comparison of complications. J Pediatr Orthop. 2014;34(8):749-55. doi: 10.1097/BPO.0000000000000210.
- 9. Dinçer R, Köse A, Topal M, Öztürk İA, Engin MÇ. Surgical treatment of pediatric forearm fractures with intramedullary nails: is it a disadvantage to leave the tip exposed? J Pediatr Orthop B. 2020;29(2):158-163. doi: 10.1097/BPB.0000000000000635.
- 10. Simanovsky N, Tair MA, Simanovsky N, Porat S. Removal of flexible titanium nails in children. J Pediatr Orthop. 2006;26(2):188-92. doi: 10.1097/01.bpo.0000218534.51609.aa.
- 11. Shields DW, Iliadis AD, Kelly E, Heidari N, Jamal B. Pin-site Infection: A Systematic Review of Prevention Strategies. Strategies Trauma Limb Reconstr. 2022;17(2):93-104. doi: 10.5005/jp-journals-10080-1562.
- 12. Khaled M, Fadle AA, Hassan AAA, Khalifa AA, Nabil A, Hafez A et al. To Bury or Not to Bury the K-wires After Fixation of Both Bone Forearm Fractures in Patients Younger Than 11 Years Old: A Randomized Controlled Trial. J Pediatr Orthop. 2023;43(10):e783-e789. doi: 10.1097/BPO.0000000000002516.
Is it safe and effective to leave Titanium Elastic Nail (TEN) tips outside the skin in pediatric femoral diaphyseal fractures?
Abstract
Aim: In this study, we aimed to retrospectively evaluate the use of nail tips outside and under the skin in TEN (Titanium Elastic Nail) application in pediatric femur diaphyseal fractures.
Patients and methods: Forty-six patients (47 fractures) who underwent TEN due to femoral diaphyseal fractures between January 2016 and July 2019 were examined retrospectively. While the patients whose TEN ends were left outside the skin were called Group 1, the patients whose TEN ends were left under the skin were called Group 2.. Age, gender, fracture side, and follow-up periods were evaluated. Clinical evaluation; hip and knee ROM (range of motion), rotational or angular deformities, pin bottoms, incision scars, infective findings; In radiological evaluation; angulation, deformity and length differences were examined on two-way radiography. Implant removal times and all complications were evaluated.
Results: 21 fractures (Group 1) TEN ends were left outside the skin; In 26 fractures (Group 2), the TEN ends were left under the skin. Both groups had similar distributions in terms of age, gender and fracture sides. The follow-up period of Group 2 was significantly longer (p<0.05), but the minimum follow-up period in both groups was 9 months. There was a significant difference in the distribution of coronal and sagittal angulations in both groups (p<0.05), but all of the angulations were within acceptable limits in their age groups. Pin bottom discharge of both groups had similar distribution. (p>0.05) In terms of implant removal time, Group 1 achieved this in a shorter time compared to Group 2. (p<0.05) Union was achieved without any problems in all fractures in both groups. No notable angulation defects, rotation defects or shortness were observed in the patients. No patient developed infection in deep tissues.
Conclusions: In pediatric femur diaphyseal fractures, in addition to removing the implants in a short time under outpatient clinic conditions and without the need for anesthesia by leaving the TEN ends outside the skin; leaving the implant tip outside seems to be quite advantageous, since union or angulation problems are similar to nail tips being left inside. However, nail root infection is still a serious concern; therefore, we believe that this problem can be solved with close monitoring and parental education.
Ethical Statement
In this study, national and international ethical rules are observed.
References
- 1. Hedström EM, Svensson O, Bergström U, Michno P. Epidemiology of fractures in children and adolescents. Acta Orthop. 2010 ;81(1):148-53. doi: 10.3109/17453671003628780.
- 2. Kuremsky MA, Frick SL. Advances in the surgical management of pediatric femoral shaft fractures. Curr Opin Pediatr 2007;19:51-57 Kuremsky MA, Frick SL. Advances in the surgical management of pediatric femoral shaft fractures. Curr Opin Pediatr. 2007;19(1):51-7. doi: 10.1097/MOP.0b013e3280123142.
- 3. Uçar BY, Gem M, Bulut M, Azboy I, Demirtaş A, Alemdar C. Titanium elastic intramedullary nailing: closed or mini-open reduction? Acta Orthop Belg. 2013;79(4):406-10. PMID: 24205770.
- 4. Flinck M, von Heideken J, Janarv PM, Wåtz V, Riad J. Biomechanical comparison of semi-rigid pediatric locking nail versus titanium elastic nails in a femur fracture model. J Child Orthop. 2015;9(1):77-84. doi: 10.1007/s11832-014-0629-5.
- 5. Memeo A, Panuccio E, D'Amato RD, Colombo M, Boero S, Andreacchio A et al. Retrospective, multicenter evaluation of complications in the treatment of diaphyseal femur fractures in pediatric patients. Injury. 2019 Aug;50 Suppl 4:S60-S63. doi: 10.1016/j.injury.2019.01.009.
- 6. Govindasamy R, Gnanasundaram R, Kasirajan S, Ibrahim S, Melepuram JJ. Elastic Stable Intramedullary Nailing of Femoral Shaft Fracture-Experience in 48 Children. Arch Bone Jt Surg. 2018;6(1):39-46. PMID: 29430494
- 7. Combs K, Frick S, Kiebzak G. Multicenter Study of Pin Site Infections and Skin Complications Following Pinning of Pediatric Supracondylar Humerus Fractures. Cureus. 2016;8(12):e911. doi: 10.7759/cureus.911.
- 8. Kelly BA, Miller P, Shore BJ, Waters PM, Bae DS. Exposed versus buried intramedullary implants for pediatric forearm fractures: a comparison of complications. J Pediatr Orthop. 2014;34(8):749-55. doi: 10.1097/BPO.0000000000000210.
- 9. Dinçer R, Köse A, Topal M, Öztürk İA, Engin MÇ. Surgical treatment of pediatric forearm fractures with intramedullary nails: is it a disadvantage to leave the tip exposed? J Pediatr Orthop B. 2020;29(2):158-163. doi: 10.1097/BPB.0000000000000635.
- 10. Simanovsky N, Tair MA, Simanovsky N, Porat S. Removal of flexible titanium nails in children. J Pediatr Orthop. 2006;26(2):188-92. doi: 10.1097/01.bpo.0000218534.51609.aa.
- 11. Shields DW, Iliadis AD, Kelly E, Heidari N, Jamal B. Pin-site Infection: A Systematic Review of Prevention Strategies. Strategies Trauma Limb Reconstr. 2022;17(2):93-104. doi: 10.5005/jp-journals-10080-1562.
- 12. Khaled M, Fadle AA, Hassan AAA, Khalifa AA, Nabil A, Hafez A et al. To Bury or Not to Bury the K-wires After Fixation of Both Bone Forearm Fractures in Patients Younger Than 11 Years Old: A Randomized Controlled Trial. J Pediatr Orthop. 2023;43(10):e783-e789. doi: 10.1097/BPO.0000000000002516.
Details
| Primary Language | English |
|---|---|
| Subjects | Orthopaedics |
| Journal Section | Research Article |
| Authors | |
| Publication Date | April 30, 2024 |
| Submission Date | December 27, 2023 |
| Acceptance Date | March 20, 2024 |
| Published in Issue | Year 2024 Volume: 8 Issue: 1 |
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